HomeMy WebLinkAbout1006 Battsford Cir - Applications/Air Conditioner - 07/22/2019A\C=4
6 City of planning, Development, & Transportation Services
t Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). l!ZQ1ir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
'LHeating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Clo a all applicabj)nformation on the application. Incomplete applications will not be accepted.
App ication # 6Jgd Lf0(Q Date \fig
For office use only
Job Site Address (requlred) Value of Construction (labor, materials, profit)
N� �� ; 11$3 C11 ice -i,-.
Property Owner Name Address City/State Zip Phone
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? $3lere ❑ Report
Sales tax number isrequired byall contractors. Are you paying with your trust account? )P'es ❑ No
3WID5
Is this a residential or commercial project? N�Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the b 'ding constructed?
Description of wor
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If t-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or City of Ft Collins license ft
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: �'1
Print Name: K"e . am)mm,, Signature Ce e� T r. Date
Revision date ZW2017
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